Causes and treatments for itchy, irritated skin

South Florida Sun-Sentinel

On April 15, we discussed the causes and treatments for itchy, irritated skin due to conditions such as eczema, psoriasis and rosacea.

Our expert panel included Dr. Marta Rendon, a board-certified dermatologist and a and a clinical associate professor at the University Of Miami Miller School Of Medicine and at Florida Atlantic University, and Dr. Ricardo Mejia, a board-certified dermatologist practicing in Jupiter, Fla.

Hello everyone. This is Bob LaMendola, a health reporter at the Sun Sentinel in Fort Lauderdale. Welcome to our chat and tjhanks for joining us.

Friday April 15, 2011 1:02 Bob LaMendola

1:03

Bob LaMendola:

Today, we are going to have an online conversation with two dermatologists, who specialize in skin conditions.

Friday April 15, 2011 1:03 Bob LaMendola

1:04

Bob LaMendola:

We are glad to have with us Dr. Marta Rendon and Dr. Ricardo Mejia, both from Palm Beach County, Fla.Please feel free to send in your questions about any type of skin condition.

Friday April 15, 2011 1:04 Bob LaMendola

1:04

Dr Ricardo Mejia:

Thank You for the Invitation. It is my pleasure to be here and answer any questions. My name is Ricardo Mejia MD from Jupiter FL

Friday April 15, 2011 1:04 Dr Ricardo Mejia

1:05

SunSentinel.com Health:

Let's start out with a question we got via email

Friday April 15, 2011 1:05 SunSentinel.com Health

1:06

SunSentinel.com Health:

Emailed question: Are there any new breakthroughs in the treatment of rosacea and what is the best non-prescription treatment out there? -- Rich

Friday April 15, 2011 1:06 SunSentinel.com Health

1:07

Bob LaMendola:

THat's a good question because April happens to be national rosacea month.

Friday April 15, 2011 1:07 Bob LaMendola

1:07

Marta I Rendon, MD:

Thank you for the invitation. There are several new treatments for Rosacea. Oral medications and laser treatments.

Friday April 15, 2011 1:07 Marta I Rendon, MD

1:09

Marta I Rendon, MD:

The treatment of Rosacea is usually a combination of topical products and systemic anti inflammatory oral medications. The common medications are Metrogel and Finacea. Oral antibiotics in low dose are usually used. The newer laser technologies that help the vascular component

Friday April 15, 2011 1:09 Marta I Rendon, MD

1:09

[Comment From GeorgeGeorge: ]

Effect of diet or the so-called "Rosacea Diet" in treating Rosacea

Friday April 15, 2011 1:09 George

1:10

Bob LaMendola:

For those who don't know, rosacea is a reddening of the skin that has no cure at this time and the causes are unknown.

Friday April 15, 2011 1:10 Bob LaMendola

1:11

Dr Ricardo Mejia:

Rosacea can be triggered by a variety fo foods such as spicy foods, red wines and certain cheeses. In many cases patients are given a list of foods to avoid.

Friday April 15, 2011 1:11 Dr Ricardo Mejia

1:11

Marta I Rendon, MD:

Diet in Rosacea patients is very important. Hot spicy foods, caffeine can affect some patients.

Friday April 15, 2011 1:11 Marta I Rendon, MD

1:11

Dr Ricardo Mejia:

Psoriasis (sore-EYE-ah-sis) is a chronic (long-lasting) disease. It develops when a person's immune system sends faulty signals that tell skin cells to grow too quickly. New skin cells form in days rather than weeks. The body does not shed these excess skin cells. The skin cells pile up on the surface of the skin, causing patches of psoriasis to appear.

Friday April 15, 2011 1:11 Dr Ricardo Mejia

1:12

[Comment From GabbyGabby: ]

Do you know what causes psoriasis? I first started getting it when I was about 30 years old, mostly on my elbows. I'm now 55.

Friday April 15, 2011 1:12 Gabby

1:12

Dr Ricardo Mejia:

Psoriasis is a genetic condition affecting 1% of the population

Friday April 15, 2011 1:12 Dr Ricardo Mejia

1:13

Marta I Rendon, MD:

The cause of Psoriasis is unknown. We do know there is an autoimmune component and also a genetic component. Unfortunately there is no cure, but there are many treatments available today, from creams to oral medications to injectable agents

Friday April 15, 2011 1:13 Marta I Rendon, MD

1:13

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

People with psoriasis are at increased risk for other serious health conditions like heart disease and diabetes. What's the importance of maintaining overall health in people with psoriasis?

Friday April 15, 2011 1:13 Psoriasis Foundation

1:13

Dr Ricardo Mejia:

There are several over the counter treatments such as coal tar which have worked well for my patients. Otherwise other topical treatments such as topical steroids are used.

Friday April 15, 2011 1:13 Dr Ricardo Mejia

1:15

[Comment From JohnnyJohnny: ]

will we ever reseach enogh to find the causes of eczema and such itchy probles that cause bad skin disorders some of the cures now can be more dangerous than the problem.and why is it the most effective treatments like lasers treatment so expensive when high tect equipment is really cheap to make.

Friday April 15, 2011 1:15 Johnny

1:16

Marta I Rendon, MD:

A lot of new research has shown that Psoriasis patients may have what is called co-morbid conditions. Yes, cardiac and diabetes. Cardiac diseases in particular. The good news is that current treatments actually have shown to reduce the of death from cardiac conditions,.

Friday April 15, 2011 1:16 Marta I Rendon, MD

1:16

Dr Ricardo Mejia:

JOohnny. There are many reasons for eczema. The problem is finding the cause. It may be an irritant, and allergy or atopic dermatitis.

Friday April 15, 2011 1:16 Dr Ricardo Mejia

1:16

Bob LaMendola:

FYI, Dr. Rendon's answer pertains to the comment from the Psoriasis Foundation.

Friday April 15, 2011 1:16 Bob LaMendola

1:16

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

Dr. Rendon: since people often ask us at the National Psoriasis Foundation if psoriasis "just affects the skin," could you explain for them what's happening to their immune system?

Friday April 15, 2011 1:16 Psoriasis Foundation

1:17

Dr Ricardo Mejia:

I can't comment on the cost of the equipment. Generally we are not utilizing expensive lasers for eczema. It is more topical therapy and trigger avoidance.

Friday April 15, 2011 1:17 Dr Ricardo Mejia

1:18

Dr Ricardo Mejia:

 Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an irritating acid, a cleaning agent, or other chemical   Allergic contact eczema: a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions like Neosporin or Bacitracin   Seborrheic eczema (also called seborrheic dermatitis or seborrhea): is a very common form of mild skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, ears, and occasionally other parts of the body. Often this is also called dandruff in adults or "cradle cap" in infants.   Nummular eczema: coin-shaped (round), isolated patches of irritated skin -- most commonly on the arms, back, buttocks, and lower legs -- that may be crusted, scaling, and extremely itchy   Neurodermatitis: a very particular type of dermatitis where the person frequently picks at their skin, causing rashes. The underling cause may be a sensitivity or irritation which sets off a cascade of repeated itching and scratching cycles. It may be seen as scratch marks and pick marks on the skin. Sometimes scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) may become intensely irritated when scratched.   Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems and congestion of the leg veins. It may have a darker pigmentation, light-brown, or purplish-red discoloration from the congestion and back up of the blood in the leg veins. It's sometimes seen more in legs with varicose veins.

Friday April 15, 2011 1:18 Dr Ricardo Mejia

1:19

Marta I Rendon, MD:

We now believe that psoriasis is an immune mediated disease. They have a derangement in their T cells. The newer biologic agents block different pathways of the immune system

Friday April 15, 2011 1:19 Marta I Rendon, MD

1:20

[Comment From RandyRandy: ]

I have deep red patches on my legs that get dry and flaky. The creams they give me to get rid of it only temporarily get rid of it.

Friday April 15, 2011 1:20 Randy

1:20

Dr Ricardo Mejia:

Eczema on the lower legs can be related to stasis dermatitis or nummular eczema as above.

Friday April 15, 2011 1:20 Dr Ricardo Mejia

1:21

Dr Ricardo Mejia:

I would also check depending on your age whether you have severe varicose veins.

Friday April 15, 2011 1:21 Dr Ricardo Mejia

1:21

[Comment From Kim SmithKim Smith: ]

My 5 year old son has excema. The only trigger seems to be our dog. We have been swimming more often recently and his excema seems to be worse; however he is spending more time with our dog. Is chlorine something that could be making it worse. Please advise any tips beyond moisturizer. We use a steroid cream to treat it and I am hesitant to use it too much. Thanks!

Friday April 15, 2011 1:21 Kim Smith

1:25

Marta I Rendon, MD:

As you know eczema is triggered by a multitude of factors. Your son can be tested for pet allergies. I would recommend that you do that just to make sure.Regarding chlorine, we know that it dries the skin out. Bad for eczema. Try mild soap, non cleansers, fragrance free low PH cleansing products after he comes home from pool. ointments are better if his skin is very dry and right after he showers

Friday April 15, 2011 1:25 Marta I Rendon, MD

1:25

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

Dr. Mejia: Psoriasis is the most chronic autoimmune disease in the country, affecting up to 7.5 million Americans - or roughly 2-3 percent of the worldwide population.

Friday April 15, 2011 1:25 Psoriasis Foundation

1:25

Dr Ricardo Mejia:

The psoriasis foundation at www.psoriasis.org is an excellent source of information for all the up to date information research and treatments for psoriasis as well as statistics.

Friday April 15, 2011 1:25 Dr Ricardo Mejia

1:26

[Comment From MarkMark: ]

my 5 year old son scratches his scalp a lot , mostly when trying to sleep at night. Any suggestions as to treatment? benadryl seems to help a little. i see no rashes of any kind on his scalp.

Friday April 15, 2011 1:26 Mark

1:26

Dr Ricardo Mejia:

Scalp itching in a young kid could be lice, psoriasis or even seborrheic dermatitis although rarer. Some children may also exhibit neurotic itching or obsessive compulsive habits. There is also a condition called trichotillomania of constant hair twirling which can lead to temporary hair loss.

Friday April 15, 2011 1:26 Dr Ricardo Mejia

1:27

SunSentinel.com Health:

Emailed question: What are options for treating psoriasis if people don't have insurance? -- Sarah

Friday April 15, 2011 1:27 SunSentinel.com Health

1:27

Bob LaMendola:

That's so important because we have so many people with no coverage, especially here in Florida.

Friday April 15, 2011 1:27 Bob LaMendola

1:28

Marta I Rendon, MD:

If you don't insurance and your psoriasis is not severe you can get products with cortisone over the counter and also products with coal tar. Coal tar shampoos are over the counter as well as products with zinc pyrithione.

Friday April 15, 2011 1:28 Marta I Rendon, MD

1:28

[Comment From RandyRandy: ]

It seems more like Nummular eczema primarily on my lower legs.

Friday April 15, 2011 1:28 Randy

1:29

Dr Ricardo Mejia:

Randy. unfortunately without a proper exam to diagnose your condition. I could not give you a for sure answer. However, start with good moisturization and possibly over the counter topical hydrocortisone. If things are not improving, definitely see your dermatologist for a proper diagnosis. If you are older, skin cancers can look like eczema.

Friday April 15, 2011 1:29 Dr Ricardo Mejia

1:29

[Comment From GailGail: ]

My husband has allergies and asthma, and very very dry scaly skin. He uses Eurcerin Calming Cream, but he mostly just lives with it. Any suggestions?

Friday April 15, 2011 1:29 Gail

1:30

Dr Ricardo Mejia:

Nummular eczema is typically treated with steroids and moisturization

Friday April 15, 2011 1:30 Dr Ricardo Mejia

1:30

Dr Ricardo Mejia:

try the greasy stuff like aquaphor for really dry skin

Friday April 15, 2011 1:30 Dr Ricardo Mejia

1:30

Marta I Rendon, MD:

It is very important for him to keep his skin moisturized. Make sure to have mild soaps handy and he might benefit from a mild cortisone cream if not responding to over the counter products.

Friday April 15, 2011 1:30 Marta I Rendon, MD

1:31

[Comment From GeorgeGeorge: ]

How long should it take before Finacea shows results and a decision be made to stop or continue its use.

Friday April 15, 2011 1:31 George

1:32

Marta I Rendon, MD:

You should use it for at least 4 to 6 weeks before you decide that it does not work.

Friday April 15, 2011 1:32 Marta I Rendon, MD

1:32

Bob LaMendola:

FYI, Finacea is a gel known as azelaic acid.

Friday April 15, 2011 1:32 Bob LaMendola

1:33

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

Up to 30 percent of people with psoriasis develop psoriatic arthritis, a related condition causing swelling of the joints. We recommend that people talk with their doctor if they experience joint pain, stiffness or swelling lasting more than 3 days. What symptoms should people look for?

Friday April 15, 2011 1:33 Psoriasis Foundation

1:33

Dr Ricardo Mejia:

The symptoms of the most common form of psoriatic arthritis affects the tips of the fingers or toes. However, one in five cases of the condition can affect the spine. The least common form of psoriatic arthritis is called "psoriatic arthritis mutilans," which targets the joints, causing severe destruction. Most patients typically have joint pain

Friday April 15, 2011 1:33 Dr Ricardo Mejia

1:34

SunSentinel.com Health:

Emailed question: My son has renal disease and horrible skin. I have seen several dermatologists and have gotten no answers. Are you aware of skin conditions associated with renal failure?

Friday April 15, 2011 1:34 SunSentinel.com Health

1:34

Dr Ricardo Mejia:

Kyrle disease has been associated with patients with kidney problems. The cause of the disease is unknown. Some cases appear to be idiopathic (no known triggers), or inherited. What has been found is that Kyrle disease appears to occur more frequently in patients with certain systemic disorders such as Diabetes mellitus , Renal disease (chronic renal failure, albuminuria, elevated serum creatinine, abnormal creatinine clearance, polyuria) , Hepatic abnormalities (alcoholic cirrhosis) , Congestive heart failure . Treatments have included topical steroids and isotretinoin as well as antihistamines.

Friday April 15, 2011 1:34 Dr Ricardo Mejia

1:34

[Comment From EdEd: ]

Can topical use of the anti-fungal ketoconazole cause abnormal liver function tests or gynecomastia? If so, how would you treat sebborheic eczema presumably caused by the yeast malassezia?

Friday April 15, 2011 1:34 Ed

1:36

Marta I Rendon, MD:

There is a condition called Lichen Simplex Chronicus which is thickening of the skin and increased pigmentation. To treat the itching you need steroid creams and bleaching creams to treat the pigmentation. Look for products with Hidroquinone 2% is available OTC, but make sure if does not irritate you. Also remember to use your sunscreen!

Friday April 15, 2011 1:36 Marta I Rendon, MD

1:37

SunSentinel.com Health:

Emailed question: I have itchy patches on my breast. My doctor has given me Lamisil, which hasn't worked. I am worried that it could be breast cancer, but are there any other creams I can try before taking more expensive steps to check for cancer. -- Anne

Friday April 15, 2011 1:37 SunSentinel.com Health

1:38

Dr Ricardo Mejia:

I would recommend seeing your dermatologist again for the patches on your breast. You may even want to request a biopsy if you are concerned about a breast cancer. There is a known condition called Pagets disease which is a malignancy of the breast. Pagets typically involves one breast area. When both areas are involved, we tend to think of irritations or allergies from bras. BUt generally, we do do a biopsy to rule out Pagets disease.

Friday April 15, 2011 1:38 Dr Ricardo Mejia

1:38

Dr Ricardo Mejia:

Lamasil is an antifungal .

Friday April 15, 2011 1:38 Dr Ricardo Mejia

1:38

[Comment From AmandaAmanda: ]

I was diagnosed with eczema when I was 12. Everytime I get an irritated area under control through medications... another spot appears somewhere else. Is this normal?

Friday April 15, 2011 1:38 Amanda

1:40

Marta I Rendon, MD:

Yes Amanda, Eczema can pop up anywhere in the body. Make sure you keep skin moisturized at all times and this is a good preventive measure, specially in cold weather

Friday April 15, 2011 1:40 Marta I Rendon, MD

1:40

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

Getting psoriasis under control is important. The National Psoriasis Foundation can connect you with many resources to help you access medical services and treatments. Check out our Health Insurance Action Center for further assistance/details with insurance issues: http://www.psoriasis.org/NetCommunity/Page.aspx?pid=1269

Friday April 15, 2011 1:40 Psoriasis Foundation

1:40

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

When is it appropriate to get a second opinion from a dermatologist when you have any disease affecting the skin?

Friday April 15, 2011 1:40 Psoriasis Foundation

1:41

Dr Ricardo Mejia:

If you ANY disease affecting your skin that is not resolviong, I would recommend a second opinion if several treatments have failed. You do not want to miss a skin cancer masquerading as a rash.

Friday April 15, 2011 1:41 Dr Ricardo Mejia

1:42

Marta I Rendon, MD:

Dermatologists treat skin, hair and nail conditions. Of course if you have a problem that is not getting better with proper treatment you should seek a dermatologist.

Friday April 15, 2011 1:42 Marta I Rendon, MD

1:44

Bob LaMendola:

Let me ask a question. In rosacea, if you don't attend to it promptly, can it progress to somethign more serious?

Friday April 15, 2011 1:44 Bob LaMendola

1:45

Dr Ricardo Mejia:

Generally speaking rosacea does not progress to more serios symptoms. However, you do want to have a proper diagnosis. In some cases the facial redness can be a sign of lupus rather than rosacea.

Friday April 15, 2011 1:45 Dr Ricardo Mejia

1:45

Dr Ricardo Mejia:

Some patietns can develop a disfiguring problem caused rhinophyma. This is typically in patients that have a predisposition to the problem

Friday April 15, 2011 1:45 Dr Ricardo Mejia

1:46

[Comment From JennyJenny: ]

How does one determine if facial redness spots are caused by a breakdown of blood vessels or Rosacea - or are they one in the same.

Friday April 15, 2011 1:46 Jenny

1:48

Marta I Rendon, MD:

Facial redness can have different causes. Rosacea is just one of them. Dilated blood vessels give the impression of redness due to increased blood flow. Dermatologists have an instrument which magnifies the skin and they can see if they are blood vessels or just inflamation.

Friday April 15, 2011 1:48 Marta I Rendon, MD

1:48

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

How should people prepare for their dermatology appointment? The National Psoriasis Foundation website at www.psoriasis.org has lots of patient resources to get you started.

Friday April 15, 2011 1:48 Psoriasis Foundation

1:48

Dr Ricardo Mejia:

The best thing is to make a list of all there treatments and to bring any and all medications with them that they have used. Getting advanced records from their prior doctor visits would help.

Friday April 15, 2011 1:48 Dr Ricardo Mejia

1:50

Marta I Rendon, MD:

Patients should bring all their old medical records. Remember to bring names of previous creams and previous treatments. If a biopsy has been done, very important to get the results as well.

Friday April 15, 2011 1:50 Marta I Rendon, MD

1:50

SunSentinel.com Health:

Emailed question: Late last year I accidentally hit my right leg which I believe began a series of rashes and itchy skin all the way up to my buttocks. I was diagnosed with Urticaria and she prescribed triam/cetaphil cream fougera, which didn't help. Another doctor prescribed prednisone, Tramcinolone Acetonide Cream and Doxepin HL 10 mg, which helped somewhat but I still have itch, rash and discomfort. What can I do? -- Helen

Friday April 15, 2011 1:50 SunSentinel.com Health

1:51

Dr Ricardo Mejia:

A skin biopsy of the rash will always assure a proper diagnosis. If things are not improving, I typically increase the strength of the topical steroid or change it. I also may increase the dosage of antihistamines or try a combination. I may also look for other causes such as allergic contact dermatitis and consider patch testing to rule out allergies. There are also special blood tests to rule out an autoimmune urticarial problem.

Friday April 15, 2011 1:51 Dr Ricardo Mejia

1:51

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

With summer coming, people are getting sunburns, scratching on their knees and other "injuries" to the skin. Could you explain what the Koebner effect is? Many people ask us about psoriasis triggers.

Friday April 15, 2011 1:51 Psoriasis Foundation

1:52

Marta I Rendon, MD:

Koebner effect is the reproduction of the disease in areas of trauma. Therefore is very important not to traumatize the skin by excessive scratching.

Friday April 15, 2011 1:52 Marta I Rendon, MD

1:53

Dr Ricardo Mejia:

The Koebner phenomenon (Koebnerization, isomorphic response) occurs when a new area of psoriasis develops in injured skin. For example, after a surgery, psoriasis may develop around the surgical scar. This phenomenon may also help explain why psoriasis tends to occur on areas of constant low-intensity trauma such as elbows and knees. Koebnerization can occur after non-traumatic skin injury such as a sunburn, or an allergic reaction to a medication. In patients who suffer from dandruff or seborrheic dermatitis of the face and scalp, psoriasis can superimpose itself due to irritation and scratching and a crossover or combination dermatitis known as "sebopsoriasis" develops. Koebnerization is not specific to psoriasis.

Friday April 15, 2011 1:53 Dr Ricardo Mejia

1:54

Bob LaMendola:

Can you tell us. Can itchy skin be a sign of skin cancer?

Friday April 15, 2011 1:54 Bob LaMendola

1:56

Dr Ricardo Mejia:

Yes it can. Rashes can be a sign of skin cancer. Generalized itching or all over can sometimes be a sign of an internal malignancy or a problem with the kidneys or liver.

Friday April 15, 2011 1:56 Dr Ricardo Mejia

1:56

Bob LaMendola:

We're almost out of time, does anyone want to submit any final questions?

Friday April 15, 2011 1:56 Bob LaMendola

1:57

Dr Ricardo Mejia:

The symptoms of pruritus or itching may differ in patients with lymphoma for example . Pruritus of the nostrils has been associated with brain tumors.

Friday April 15, 2011 1:57 Dr Ricardo Mejia

1:58

Marta I Rendon, MD:

Skin cancer is treatable and curable if caught early. Therefore any new growth, or any change in color, shape of a mole is important. As well as any spot that does not heal, itch or if it bleeds can all be signs of skin cancer.

Friday April 15, 2011 1:58 Marta I Rendon, MD

1:58

SunSentinel.com Health:

Emailed question: How do you treat a dry scalp  MINUS the store bought dandruff shampoo  what if that doesn't work?

Friday April 15, 2011 1:58 SunSentinel.com Health

1:59

Dr Ricardo Mejia:

Dry scalp assuming it is seborrhea or psoriasis can be treated with prescription strength shampoos as well as topical steroids.

Friday April 15, 2011 1:59 Dr Ricardo Mejia

1:59

Dr Ricardo Mejia:

You would be best seeing your dermatologist for this treatment.

Friday April 15, 2011 1:59 Dr Ricardo Mejia

2:01

Marta I Rendon, MD:

There are products with peanut oils and other moisturizing conditioners that help dry scalp. If you do have dandruff, look for OTC products or shampoos with Zinc Pyrithione, which is the best active ingredient, and has a lot of research behind it.

Friday April 15, 2011 2:01 Marta I Rendon, MD

2:01

[Comment From Psoriasis FoundationPsoriasis Foundation: ]

Thank you, Dr. Meija and Dr. Rendon. We hope to work with you soon at the National Psoriasis Foundation. We appreciate the time you took to answer everyone's questions and for the information you provided our community about psoriasis.